Provider Demographics
NPI:1184962656
Name:FRETWELL, NICOLE HELENE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:HELENE
Last Name:FRETWELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-3808
Mailing Address - Country:US
Mailing Address - Phone:407-614-5424
Mailing Address - Fax:321-221-1040
Practice Address - Street 1:13275 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3984
Practice Address - Country:US
Practice Address - Phone:407-905-8827
Practice Address - Fax:321-221-1040
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist